Ma Xiaoxiao, Lu Qian, Lu Yuhan, Li Xin
Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Interventional Therapy, Peking University Cancer Hospital & Institute, NO.52 Fucheng Road, Haidian District, Beijing, 100142, China.
School of Nursing, Peking University, Beijing, China.
Support Care Cancer. 2022 Oct;30(10):8119-8127. doi: 10.1007/s00520-022-07255-4. Epub 2022 Jul 2.
The purpose of this study is to determine the risk of constipation and to identify the significant risk factors for constipation in patients with gastrointestinal cancer using the Chinese version of the constipation risk assessment scale (CRAS-C), as well as to explore the complementary constipation risk factors in patients with gastrointestinal cancer, to improve the specificity of the CRAS-C in this population, and finally to provide a theoretical basis for constipation prevention.
A cross-sectional study involving multiple centers was conducted. A total of 190 patients with gastrointestinal cancer completed surveys that included demographic information, defecation habits, and the CRAS-C. The mean, SD, median, maximum, minimum, frequency, and percentage were used as indicators for the constipation risk and significant risk factors. The t test and Chi-square tests were used to analyze constipation indicators in patients with gastrointestinal cancer.
The mean (SD) age of the 190 participants was 61.68 (12.35) years. The total CRAS-C mean (SD) score was 13.22 (4.69). Fifty-one patients (26.8%) scored lower than 11, who were at the low-risk level of constipation. One hundred thirty-nine patients (73.2%) scored 11 or above, who were at the high-risk level of constipation. The top 10 factors were insufficient liquid intake (81.1%), failure to consume bran products daily (78.9%), insufficient fiber intake (77.9%), antiemetics (74.7%), cytotoxic chemotherapy (52.6%), colorectal/abdominal diseases (42.6%), female (35.3%), opioid analgesics(26.8%), calcium channel blockers (16.3%), and endocrine disorders (14.2%). Chi-square test showed that constipating for most of the past 3 months, ascites and ECOG score were complementary constipation risk factors in gastrointestinal cancer patients.
The findings indicate that most gastrointestinal cancer patients were at a high risk of constipation. There are also several complementary constipation risk factors, and CRAS-C can be further revised in future studies to make it more specific in gastrointestinal cancer patients. Integrating CRAS into the pathway of constipation management, carrying out constipation risk screening for hospitalized cancer patients, and building systematic constipation prevention plan based on risk assessment are important to reduce the incidence of constipation in patients with gastrointestinal cancer and improve the quality of life.
本研究旨在使用中文版便秘风险评估量表（CRAS-C）确定胃肠道癌患者便秘的风险，并识别便秘的重要危险因素，同时探索胃肠道癌患者中便秘的补充危险因素，以提高CRAS-C在该人群中的特异性，最终为便秘预防提供理论依据。
开展一项多中心横断面研究。共有190例胃肠道癌患者完成了包括人口统计学信息、排便习惯及CRAS-C在内的调查。采用均值、标准差、中位数、最大值、最小值、频数和百分比作为便秘风险及重要危险因素的指标。采用t检验和卡方检验分析胃肠道癌患者的便秘指标。
190名参与者的平均（标准差）年龄为61.68（12.35）岁。CRAS-C总均分（标准差）为13.22（4.69）。51例患者（26.8%）得分低于11分，处于便秘低风险水平。139例患者（73.2%）得分11分及以上，处于便秘高风险水平。前10个因素依次为液体摄入量不足（81.1%）、未每日食用麸类产品（78.9%）、膳食纤维摄入不足（77.9%）、使用止吐药（74.7%）、细胞毒性化疗（52.6%）、结直肠/腹部疾病（42.6%）、女性（35.3%）、阿片类镇痛药（26.8%）、钙通道阻滞剂（16.3%）和内分泌紊乱（14.2%）。卡方检验显示，过去3个月大部分时间便秘、腹水和ECOG评分是胃肠道癌患者便秘的补充危险因素。
研究结果表明，大多数胃肠道癌患者存在便秘高风险。还存在一些便秘补充危险因素，未来研究可对CRAS-C进一步修订，使其在胃肠道癌患者中更具特异性。将CRAS纳入便秘管理路径，对住院癌症患者进行便秘风险筛查，并基于风险评估制定系统的便秘预防计划，对于降低胃肠道癌患者便秘发生率及提高生活质量具有重要意义。
